Anna Gorman

PORTLAND – Samantha McVey brought her 4-month-old daughter, Ruby, to The Children’s Clinic for a routine check-up and vaccinations. But within minutes of sitting down with Dr. R.J. Gillespie, McVey was describing her turbulent childhood with a drug-addicted father who spent time in prison.

“How do you think that affects your parenting now?” Dr. Gillespie asked.

“I don’t want my kids to have to go through that,” said Ms. McVey, 23.

©KatarzynaBialasiewicz/thinkstockphotos.com

Ms. McVey told the doctor she considers herself a good mom but occasionally loses her temper and yells at Ruby’s 5-year-old sister, Madison. “Sometimes I get to the point where I’m crazy,” she said.

Dr. Gillespie is among a growing number of pediatricians across the country going beyond the typical well-child visit and delving deeper into the history of families like McVey’s. The goal is to prevent children from experiencing traumatic events that can interfere with their brain development and increase their risk of physical and emotional problems in adulthood.

A growing body of research shows that children who experience abuse, neglect, or other “toxic stress” have a greater likelihood of developing chronic diseases when they get older.

In response, the American Academy of Pediatrics is urging doctors to intervene by identifying and offering assistance to parents and young patients they believe to be at risk. The academy has not endorsed a specific screening tool, and doctors around the country, including in California, Massachusetts, and Maryland, are trying different approaches.

Dr. Gillespie and the doctors in his practice are trying to identify parents who have had traumatic upbringings to help prevent them from raising their children in the same way.

“Most of what we learn about being parents obviously comes from how our parents treated us,” Dr. Gillespie told Ms. McVey during her recent visit. “We’re trying to understand where parents are coming from so we can find the people who might need a little bit more help.”

Gillespie’s former partner, Dr. Teri Pettersen, has left the practice to get the message out. She now does training for the Oregon Pediatric Society on the issue of toxic stress and the role of doctors in preventing it.

“We were trained to deal with diabetes,” Dr. Pettersen recently told a crowd of doctors and other staff of the Providence Medical Group in Portland. “We were trained how to deal with hypertension. I don’t think anybody was really trained on how to address some of these adverse childhood experiences.”

Persuasive Research

Between 1995 and 1997, researchers conducted a seminal study on toxic stress, based on more than 17,000 Kaiser Permanente patients in San Diego.

It showed that adults who had more dysfunction in their homes as children were more likely to have cancer, chronic lung disease, and heart disease, as well as depression and substance abuse problems. Patients were asked questions about childhood, including whether a parent was mentally ill, imprisoned, or alcoholic and whether they suffered physical or sexual abuse.

Researchers from Kaiser Permanente and the Centers for Disease Control and Prevention found that people with four or more “adverse childhood experiences” were twice as likely as those with none to have cancer and four times as likely to have emphysema. The reasons are complex, but one explanation is that such stress leads to unhealthy lifestyle choices, such as smoking. Also, it can affect hormones like cortisol in a way that ultimately damages the body’s organs, and can alter how genes are expressed and the brain develops.

More than 50 research articles have been written based on the data from the Kaiser Permanente patients, who are still being followed. Researchers have found that later-life problems can be reduced if children are able to develop a healthy relationship with a parent or caregiver, or get certain clinical treatments. (Kaiser Health News is not affiliated with Kaiser Permanente.)

Dr. Andrew S. Garner, who is leading a work group for the American Academy of Pediatrics, said the science about toxic stress is clear. The harder part, Dr. Garner said, is figuring out how pediatricians can best use the research – especially how to have conversations about tough childhoods without alienating families. “We’re struggling to try and translate what we know into what we do in clinical practice,” he said.

That’s what Dr. Gillespie and Dr. Pettersen set out to do.

'So Nice To Get Advice’

At The Children’s Clinic, where stuffed monkeys hang from cut-out trees in the lobby and children flip through colorful storybooks, they created a survey in 2013 asking parents about their past experience with abuse, neglect, bullying, foster care, and neighborhood violence.

“We really want to be about prevention,” Dr. Gillespie said. “If we can be a little more upstream and prevent that cycle from repeating itself that will be the ultimate success.”

Parents are also asked to complete a separate questionnaire to measure their resilience – their ability to bounce back from difficult situations – so doctors can identify potential strengths to build on. The clinic, which serves a mostly insured population of diverse ethnic backgrounds, has screened more than 2,000 parents so far. About 40% indicated one traumatic childhood experience; 8% had four or more.

The most common was separation or divorce, followed by substance abuse and mental health issues in the family. The doctors offer tips on parenting or discipline to families who seem most in need. They also try to connect them with parenting classes or support groups.

At the beginning, Dr. Gillespie said it was difficult to bring up such personal questions, and he knows that not all parents are completely honest about their upbringing. But, he said, over time the screening has led to important conversations that wouldn’t have happened before, including about domestic violence. “I couldn’t go back to where we were before,” he said.

Several doctors in his office expressed skepticism at first, saying screening would take too much time and would open a can of worms. But they later said knowing more about their patients was helpful, and now 27 of the 28 providers use the screening, Dr. Gillespie said.

Others in Portland say poor families may not have the means to follow up on referrals to counseling or social services. And some argue that asking invasive questions can re-traumatize families. They say pediatricians should instead focus on educating all families in their practices.

But Ms. McVey, who brought in her daughter for a check-up with Dr. Gillespie, said she was glad to learn more about how her past could affect her children. “You may not realize that just because someone in your family had a drug problem that your kids may suffer from that,” she said. Ms. McVey remembers her father, who died earlier this year, having violent outbursts. Once, when she was 12, he left her alone in a hotel room to go get high. “As a kid, it’s tough watching your parent spiral out of control,” she said.

Ms. McVey said she doesn’t touch alcohol or drugs and tries to be patient with her daughters. But sometimes Madison can be really hyper – jumping off furniture and accidentally breaking dishes. “I yell at her, she starts crying and I start crying,” she said.

Dr. Gillespie suggested to her that Madison may also be trying to get her attention. As you play together, he said, praise her consistently. But as soon as Madison starts jumping on the couch, Gillespie said, you should immediately become silent. “She is probably going to stop because she is going to want to go back to the talking mom,” he said.

“It’s so nice to get advice on how to handle this,” Ms. McVey said afterward.

Another parent, 33-year-old Sarah Pike, who filled out the survey during a recent visit, marked “yes” to the questions about being emotionally and physically abused as a child.

“I was really afraid to become a parent,” Ms. Pike, 33, told Dr. Gillespie, as her infant daughter Payton rolled over on the exam table. “I was afraid that I was going to be a really mean person.”

“What do you think kept that from happening?” Gillespie asked.

“Remembering the torture I went through as a child and not wanting my children to be treated like I was,” Ms. Pike responded.

Dr. Gillespie told her that understanding what she went through in her own childhood is helpful – and will continue to be as she has ups and downs with Payton and her siblings.

Asking these questions can assure patients that his office is a safe place to raise sensitive problems that might otherwise go unaddressed, Dr. Gillespie explained.

“My families are getting the message that they can talk to me about whatever they need to,” he said.

Kaiser Health News is a nonprofit national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.

PORTLAND – Samantha McVey brought her 4-month-old daughter, Ruby, to The Children’s Clinic for a routine check-up and vaccinations. But within minutes of sitting down with Dr. R.J. Gillespie, McVey was describing her turbulent childhood with a drug-addicted father who spent time in prison.

“How do you think that affects your parenting now?” Dr. Gillespie asked.

“I don’t want my kids to have to go through that,” said Ms. McVey, 23.

©KatarzynaBialasiewicz/thinkstockphotos.com

Ms. McVey told the doctor she considers herself a good mom but occasionally loses her temper and yells at Ruby’s 5-year-old sister, Madison. “Sometimes I get to the point where I’m crazy,” she said.

Dr. Gillespie is among a growing number of pediatricians across the country going beyond the typical well-child visit and delving deeper into the history of families like McVey’s. The goal is to prevent children from experiencing traumatic events that can interfere with their brain development and increase their risk of physical and emotional problems in adulthood.

A growing body of research shows that children who experience abuse, neglect, or other “toxic stress” have a greater likelihood of developing chronic diseases when they get older.

In response, the American Academy of Pediatrics is urging doctors to intervene by identifying and offering assistance to parents and young patients they believe to be at risk. The academy has not endorsed a specific screening tool, and doctors around the country, including in California, Massachusetts, and Maryland, are trying different approaches.

Dr. Gillespie and the doctors in his practice are trying to identify parents who have had traumatic upbringings to help prevent them from raising their children in the same way.

“Most of what we learn about being parents obviously comes from how our parents treated us,” Dr. Gillespie told Ms. McVey during her recent visit. “We’re trying to understand where parents are coming from so we can find the people who might need a little bit more help.”

Gillespie’s former partner, Dr. Teri Pettersen, has left the practice to get the message out. She now does training for the Oregon Pediatric Society on the issue of toxic stress and the role of doctors in preventing it.

“We were trained to deal with diabetes,” Dr. Pettersen recently told a crowd of doctors and other staff of the Providence Medical Group in Portland. “We were trained how to deal with hypertension. I don’t think anybody was really trained on how to address some of these adverse childhood experiences.”

Persuasive Research

Between 1995 and 1997, researchers conducted a seminal study on toxic stress, based on more than 17,000 Kaiser Permanente patients in San Diego.

It showed that adults who had more dysfunction in their homes as children were more likely to have cancer, chronic lung disease, and heart disease, as well as depression and substance abuse problems. Patients were asked questions about childhood, including whether a parent was mentally ill, imprisoned, or alcoholic and whether they suffered physical or sexual abuse.

Researchers from Kaiser Permanente and the Centers for Disease Control and Prevention found that people with four or more “adverse childhood experiences” were twice as likely as those with none to have cancer and four times as likely to have emphysema. The reasons are complex, but one explanation is that such stress leads to unhealthy lifestyle choices, such as smoking. Also, it can affect hormones like cortisol in a way that ultimately damages the body’s organs, and can alter how genes are expressed and the brain develops.

More than 50 research articles have been written based on the data from the Kaiser Permanente patients, who are still being followed. Researchers have found that later-life problems can be reduced if children are able to develop a healthy relationship with a parent or caregiver, or get certain clinical treatments. (Kaiser Health News is not affiliated with Kaiser Permanente.)

Dr. Andrew S. Garner, who is leading a work group for the American Academy of Pediatrics, said the science about toxic stress is clear. The harder part, Dr. Garner said, is figuring out how pediatricians can best use the research – especially how to have conversations about tough childhoods without alienating families. “We’re struggling to try and translate what we know into what we do in clinical practice,” he said.

That’s what Dr. Gillespie and Dr. Pettersen set out to do.

'So Nice To Get Advice’

At The Children’s Clinic, where stuffed monkeys hang from cut-out trees in the lobby and children flip through colorful storybooks, they created a survey in 2013 asking parents about their past experience with abuse, neglect, bullying, foster care, and neighborhood violence.

“We really want to be about prevention,” Dr. Gillespie said. “If we can be a little more upstream and prevent that cycle from repeating itself that will be the ultimate success.”

Parents are also asked to complete a separate questionnaire to measure their resilience – their ability to bounce back from difficult situations – so doctors can identify potential strengths to build on. The clinic, which serves a mostly insured population of diverse ethnic backgrounds, has screened more than 2,000 parents so far. About 40% indicated one traumatic childhood experience; 8% had four or more.

The most common was separation or divorce, followed by substance abuse and mental health issues in the family. The doctors offer tips on parenting or discipline to families who seem most in need. They also try to connect them with parenting classes or support groups.

At the beginning, Dr. Gillespie said it was difficult to bring up such personal questions, and he knows that not all parents are completely honest about their upbringing. But, he said, over time the screening has led to important conversations that wouldn’t have happened before, including about domestic violence. “I couldn’t go back to where we were before,” he said.

Several doctors in his office expressed skepticism at first, saying screening would take too much time and would open a can of worms. But they later said knowing more about their patients was helpful, and now 27 of the 28 providers use the screening, Dr. Gillespie said.

Others in Portland say poor families may not have the means to follow up on referrals to counseling or social services. And some argue that asking invasive questions can re-traumatize families. They say pediatricians should instead focus on educating all families in their practices.

But Ms. McVey, who brought in her daughter for a check-up with Dr. Gillespie, said she was glad to learn more about how her past could affect her children. “You may not realize that just because someone in your family had a drug problem that your kids may suffer from that,” she said. Ms. McVey remembers her father, who died earlier this year, having violent outbursts. Once, when she was 12, he left her alone in a hotel room to go get high. “As a kid, it’s tough watching your parent spiral out of control,” she said.

Ms. McVey said she doesn’t touch alcohol or drugs and tries to be patient with her daughters. But sometimes Madison can be really hyper – jumping off furniture and accidentally breaking dishes. “I yell at her, she starts crying and I start crying,” she said.

Dr. Gillespie suggested to her that Madison may also be trying to get her attention. As you play together, he said, praise her consistently. But as soon as Madison starts jumping on the couch, Gillespie said, you should immediately become silent. “She is probably going to stop because she is going to want to go back to the talking mom,” he said.

“It’s so nice to get advice on how to handle this,” Ms. McVey said afterward.

Another parent, 33-year-old Sarah Pike, who filled out the survey during a recent visit, marked “yes” to the questions about being emotionally and physically abused as a child.

“I was really afraid to become a parent,” Ms. Pike, 33, told Dr. Gillespie, as her infant daughter Payton rolled over on the exam table. “I was afraid that I was going to be a really mean person.”

“What do you think kept that from happening?” Gillespie asked.

“Remembering the torture I went through as a child and not wanting my children to be treated like I was,” Ms. Pike responded.

Dr. Gillespie told her that understanding what she went through in her own childhood is helpful – and will continue to be as she has ups and downs with Payton and her siblings.

Asking these questions can assure patients that his office is a safe place to raise sensitive problems that might otherwise go unaddressed, Dr. Gillespie explained.

“My families are getting the message that they can talk to me about whatever they need to,” he said.

Kaiser Health News is a nonprofit national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.

PORTLAND – Samantha McVey brought her 4-month-old daughter, Ruby, to The Children’s Clinic for a routine check-up and vaccinations. But within minutes of sitting down with Dr. R.J. Gillespie, McVey was describing her turbulent childhood with a drug-addicted father who spent time in prison.

“How do you think that affects your parenting now?” Dr. Gillespie asked.

“I don’t want my kids to have to go through that,” said Ms. McVey, 23.

©KatarzynaBialasiewicz/thinkstockphotos.com

Ms. McVey told the doctor she considers herself a good mom but occasionally loses her temper and yells at Ruby’s 5-year-old sister, Madison. “Sometimes I get to the point where I’m crazy,” she said.

Dr. Gillespie is among a growing number of pediatricians across the country going beyond the typical well-child visit and delving deeper into the history of families like McVey’s. The goal is to prevent children from experiencing traumatic events that can interfere with their brain development and increase their risk of physical and emotional problems in adulthood.

A growing body of research shows that children who experience abuse, neglect, or other “toxic stress” have a greater likelihood of developing chronic diseases when they get older.

In response, the American Academy of Pediatrics is urging doctors to intervene by identifying and offering assistance to parents and young patients they believe to be at risk. The academy has not endorsed a specific screening tool, and doctors around the country, including in California, Massachusetts, and Maryland, are trying different approaches.

Dr. Gillespie and the doctors in his practice are trying to identify parents who have had traumatic upbringings to help prevent them from raising their children in the same way.

“Most of what we learn about being parents obviously comes from how our parents treated us,” Dr. Gillespie told Ms. McVey during her recent visit. “We’re trying to understand where parents are coming from so we can find the people who might need a little bit more help.”

Gillespie’s former partner, Dr. Teri Pettersen, has left the practice to get the message out. She now does training for the Oregon Pediatric Society on the issue of toxic stress and the role of doctors in preventing it.

“We were trained to deal with diabetes,” Dr. Pettersen recently told a crowd of doctors and other staff of the Providence Medical Group in Portland. “We were trained how to deal with hypertension. I don’t think anybody was really trained on how to address some of these adverse childhood experiences.”

Persuasive Research

Between 1995 and 1997, researchers conducted a seminal study on toxic stress, based on more than 17,000 Kaiser Permanente patients in San Diego.

It showed that adults who had more dysfunction in their homes as children were more likely to have cancer, chronic lung disease, and heart disease, as well as depression and substance abuse problems. Patients were asked questions about childhood, including whether a parent was mentally ill, imprisoned, or alcoholic and whether they suffered physical or sexual abuse.

Researchers from Kaiser Permanente and the Centers for Disease Control and Prevention found that people with four or more “adverse childhood experiences” were twice as likely as those with none to have cancer and four times as likely to have emphysema. The reasons are complex, but one explanation is that such stress leads to unhealthy lifestyle choices, such as smoking. Also, it can affect hormones like cortisol in a way that ultimately damages the body’s organs, and can alter how genes are expressed and the brain develops.

More than 50 research articles have been written based on the data from the Kaiser Permanente patients, who are still being followed. Researchers have found that later-life problems can be reduced if children are able to develop a healthy relationship with a parent or caregiver, or get certain clinical treatments. (Kaiser Health News is not affiliated with Kaiser Permanente.)

Dr. Andrew S. Garner, who is leading a work group for the American Academy of Pediatrics, said the science about toxic stress is clear. The harder part, Dr. Garner said, is figuring out how pediatricians can best use the research – especially how to have conversations about tough childhoods without alienating families. “We’re struggling to try and translate what we know into what we do in clinical practice,” he said.

That’s what Dr. Gillespie and Dr. Pettersen set out to do.

'So Nice To Get Advice’

At The Children’s Clinic, where stuffed monkeys hang from cut-out trees in the lobby and children flip through colorful storybooks, they created a survey in 2013 asking parents about their past experience with abuse, neglect, bullying, foster care, and neighborhood violence.

“We really want to be about prevention,” Dr. Gillespie said. “If we can be a little more upstream and prevent that cycle from repeating itself that will be the ultimate success.”

Parents are also asked to complete a separate questionnaire to measure their resilience – their ability to bounce back from difficult situations – so doctors can identify potential strengths to build on. The clinic, which serves a mostly insured population of diverse ethnic backgrounds, has screened more than 2,000 parents so far. About 40% indicated one traumatic childhood experience; 8% had four or more.

The most common was separation or divorce, followed by substance abuse and mental health issues in the family. The doctors offer tips on parenting or discipline to families who seem most in need. They also try to connect them with parenting classes or support groups.

At the beginning, Dr. Gillespie said it was difficult to bring up such personal questions, and he knows that not all parents are completely honest about their upbringing. But, he said, over time the screening has led to important conversations that wouldn’t have happened before, including about domestic violence. “I couldn’t go back to where we were before,” he said.

Several doctors in his office expressed skepticism at first, saying screening would take too much time and would open a can of worms. But they later said knowing more about their patients was helpful, and now 27 of the 28 providers use the screening, Dr. Gillespie said.

Others in Portland say poor families may not have the means to follow up on referrals to counseling or social services. And some argue that asking invasive questions can re-traumatize families. They say pediatricians should instead focus on educating all families in their practices.

But Ms. McVey, who brought in her daughter for a check-up with Dr. Gillespie, said she was glad to learn more about how her past could affect her children. “You may not realize that just because someone in your family had a drug problem that your kids may suffer from that,” she said. Ms. McVey remembers her father, who died earlier this year, having violent outbursts. Once, when she was 12, he left her alone in a hotel room to go get high. “As a kid, it’s tough watching your parent spiral out of control,” she said.

Ms. McVey said she doesn’t touch alcohol or drugs and tries to be patient with her daughters. But sometimes Madison can be really hyper – jumping off furniture and accidentally breaking dishes. “I yell at her, she starts crying and I start crying,” she said.

Dr. Gillespie suggested to her that Madison may also be trying to get her attention. As you play together, he said, praise her consistently. But as soon as Madison starts jumping on the couch, Gillespie said, you should immediately become silent. “She is probably going to stop because she is going to want to go back to the talking mom,” he said.

“It’s so nice to get advice on how to handle this,” Ms. McVey said afterward.

Another parent, 33-year-old Sarah Pike, who filled out the survey during a recent visit, marked “yes” to the questions about being emotionally and physically abused as a child.

“I was really afraid to become a parent,” Ms. Pike, 33, told Dr. Gillespie, as her infant daughter Payton rolled over on the exam table. “I was afraid that I was going to be a really mean person.”

“What do you think kept that from happening?” Gillespie asked.

“Remembering the torture I went through as a child and not wanting my children to be treated like I was,” Ms. Pike responded.

Dr. Gillespie told her that understanding what she went through in her own childhood is helpful – and will continue to be as she has ups and downs with Payton and her siblings.

Asking these questions can assure patients that his office is a safe place to raise sensitive problems that might otherwise go unaddressed, Dr. Gillespie explained.

“My families are getting the message that they can talk to me about whatever they need to,” he said.

Kaiser Health News is a nonprofit national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.

After taking a 10-year break from practicing medicine to raise four sons, Dr. Kate Gibson was ready to go back to work.

The family physician had been reading about a shortage of primary care doctors and knew she could help. But when Dr. Gibson, 51, applied to work at her former hospital near Los Angeles, she was turned away. She’d been out of clinical practice too long.

“I really thought it was not going to be that hard,” she said.

Like many professionals, physicians take time off to raise children, care for sick family members, or recover from their own illnesses. Some want to return from retirement or switch from nonclinical jobs back to seeing patients. But picking up where they left off is more difficult in medicine than in most careers.

thinkstockphotos.com

In medicine, change occurs quickly. Drugs, devices, and surgical techniques that were standard a decade ago may now be obsolete. Or a returning doctor’s skills may simply be rusty.

“My hands feel like those of an intern,” said Dr. Molly Carey, 36, an Ivy League–educated doctor who recently enrolled in a Texas retraining program after 4 years away from patients.

After extended leaves, doctors must convince medical boards to reissue their licenses, hospitals to grant admitting privileges, and malpractice insurers to provide coverage. Only a handful of programs around the country are set up to help physicians brush up on their skills, and they can cost doctors thousands of dollars.

“Medical schools do a fantastic job graduating brand new medical students,” said Dr. Humayun J. Chaudhry, president of the Federation of State Medical Boards. “But what about people who have already graduated and need to get some retraining? There is clearly a dearth of those kind of training programs.”

Policy makers and professional organizations are pushing to make the process less burdensome and costly – in part because it may help ease shortages of primary care doctors.

Getting experienced doctors to dust off their white coats is cheaper than starting from scratch, said Dr. Robert Steele, director of KSTAR physician programs at Texas A&M Health Science Center, College Station. He oversees a miniresidency program at the University of Texas Medical Branch, Galveston, in which returning doctors divide their time between seeing patients and attending classes. The 3-month training includes the latest on medications, procedures, disease management, and treatment.

“[Returning doctors] just need polishing up to practice safely and competently,” Dr. Steele said.

Patient safety advocates argue that minimum standards should be set to ensure that doctors coming back after a hiatus are providing the best care possible. As it stands, no nationwide standards or requirements exist, and states have different requirements.

“Patients would like to think that any doctor who is seeing them or doing procedures on them is at the height of their career,” said Joe Kiani, founder of the Patient Safety Movement Foundation. “If a doctor has been out for a while, they are not.”

Dr. Carey had a great education, graduating from medical school at the University of Pennsylvania and completing a residency in 2011 in obstetrics and gynecology at Brown University and a Providence hospital. But after taking just 4 years off to care for a sick grandmother and another relative, she felt she needed to freshen her clinical skills. So she moved from Rhode Island to Texas to take part in the KSTAR program, hoping to gain more confidence as a surgeon and become more marketable.

Setting standards and removing obstacles

Reliable numbers of how many doctors suspend their practices aren’t available, but the American Medical Association estimated in 2011 that 10,000 doctors could reenter practice each year.

The Federation of State Medical Boards wants states to create a standard process for physicians to show they have the skills to return to medicine. It is asking licensing agencies to track whether doctors are still practicing and whether they are doing so in their area of training.

The American Academy of Pediatrics and the AMA also are trying to remove obstacles for doctors who want to return to work after taking time off. And Rep. John Sarbanes (D-Md.) has proposed legislation to help expand reentry programs for primary care doctors and help cover physicians’ costs if they agree to practice in high-need areas.

After hitting a wall with her former employer and others, Dr. Gibson enrolled in an online retraining program in San Diego, which cost her $7,000. She spent 4 months completing the courses last year and a week shadowing a family physician. Then she took a written exam and was evaluated during mock visits with “patients” played by actors.

In the end, she received two certificates – one from the program and one from the University of California, San Diego, for 180 hours of continuing medical education.

“I definitely felt more confident,” Dr. Gibson said. But she still wanted more hands-on clinical training. So she recently started a paid family medicine fellowship at the University of Southern California, seeing patients under the oversight of other doctors.

Former medical school professor Dr. Leonard Glass created the San Diego program, called the Physician Retraining and Reentry Program, in 2013. Besides retraining primary care doctors, the online program has attracted specialists who wanted to switch to primary care, as well as some restless retirees.

“Some are simply tired of being retired,” he said. “It’s sort of an itch to go back to taking care of people.”

‘Expensive and time consuming’

Several retraining programs are run by hospitals, including Cedars-Sinai Medical Center in Los Angeles. There, participants spend between 6 weeks and 3 months seeing patients under the supervision of other physicians, then discuss their cases in an exit interview to demonstrate what they learned. They leave with a letter that can be submitted to employers or hospitals.

The Cedars-Sinai program costs $5,000 a month. Dr. Leo A. Gordon, who runs it, said some doctors who call to inquire are angry about having to spend the time and money when they already have so much education and experience. But he said others are simply appreciative that “there is a way to get back in the game.”

One Cedars-Sinai graduate, Dr. Maria DiMeglio decided she wanted to return to practice as an ob.gyn. after taking off almost 6 years to care for her children and her ill mother.

“I thought I was retiring, Dr. DiMeglio said, “but I kept my options open.” She had retained her medical license and kept up with continuing education courses. But she needed to persuade her old hospital, Cedars-Sinai, to give her privileges so she could perform surgeries. The Cedars-Sinai retraining program, she said, “wasn’t difficult, but it was expensive and time consuming. Not everyone can do that.”

Hospitals set their own requirements for doctors to get credentials and privileges, but doctors who have been out of practice for more than 2 years generally must show that they are competent to see patients. Having a certificate from a reentry program helps, said Dr. David Perrott, senior vice president and chief medical officer of the California Hospital Association.

Dr. Jeff Petrozzino, a 50-year old doctor who trained in pediatrics and neonatology, knows all about that. He ran into difficulty returning to clinical practice after spending several years doing health economics research.

“I was a double board–certified physician licensed in several states,” he said. “You would think I would be able to get a job.”

When he finally did get an offer at a medical center in New Jersey, he said both the position and the state medical license were contingent on him getting retrained. He completed a 2-month program at Drexel University in 2013, where he was surprised to discover many other doctors in a similar situation.

Dr. Petrozzino said he was grateful for the program – but given the hassles of reentry, he would advise doctors to plan carefully before taking a break from practice.

“Careers are interrupted or derailed for various reasons,” he said. “The system does not readily allow for reentry.”

Kaiser Health News (KHN) is a nonprofit national health policy news service. Blue Shield of California Foundation helps fund KHN coverage in California.

After taking a 10-year break from practicing medicine to raise four sons, Dr. Kate Gibson was ready to go back to work.

The family physician had been reading about a shortage of primary care doctors and knew she could help. But when Dr. Gibson, 51, applied to work at her former hospital near Los Angeles, she was turned away. She’d been out of clinical practice too long.

“I really thought it was not going to be that hard,” she said.

Like many professionals, physicians take time off to raise children, care for sick family members, or recover from their own illnesses. Some want to return from retirement or switch from nonclinical jobs back to seeing patients. But picking up where they left off is more difficult in medicine than in most careers.

thinkstockphotos.com

In medicine, change occurs quickly. Drugs, devices, and surgical techniques that were standard a decade ago may now be obsolete. Or a returning doctor’s skills may simply be rusty.

“My hands feel like those of an intern,” said Dr. Molly Carey, 36, an Ivy League–educated doctor who recently enrolled in a Texas retraining program after 4 years away from patients.

After extended leaves, doctors must convince medical boards to reissue their licenses, hospitals to grant admitting privileges, and malpractice insurers to provide coverage. Only a handful of programs around the country are set up to help physicians brush up on their skills, and they can cost doctors thousands of dollars.

“Medical schools do a fantastic job graduating brand new medical students,” said Dr. Humayun J. Chaudhry, president of the Federation of State Medical Boards. “But what about people who have already graduated and need to get some retraining? There is clearly a dearth of those kind of training programs.”

Policy makers and professional organizations are pushing to make the process less burdensome and costly – in part because it may help ease shortages of primary care doctors.

Getting experienced doctors to dust off their white coats is cheaper than starting from scratch, said Dr. Robert Steele, director of KSTAR physician programs at Texas A&M Health Science Center, College Station. He oversees a miniresidency program at the University of Texas Medical Branch, Galveston, in which returning doctors divide their time between seeing patients and attending classes. The 3-month training includes the latest on medications, procedures, disease management, and treatment.

“[Returning doctors] just need polishing up to practice safely and competently,” Dr. Steele said.

Patient safety advocates argue that minimum standards should be set to ensure that doctors coming back after a hiatus are providing the best care possible. As it stands, no nationwide standards or requirements exist, and states have different requirements.

“Patients would like to think that any doctor who is seeing them or doing procedures on them is at the height of their career,” said Joe Kiani, founder of the Patient Safety Movement Foundation. “If a doctor has been out for a while, they are not.”

Dr. Carey had a great education, graduating from medical school at the University of Pennsylvania and completing a residency in 2011 in obstetrics and gynecology at Brown University and a Providence hospital. But after taking just 4 years off to care for a sick grandmother and another relative, she felt she needed to freshen her clinical skills. So she moved from Rhode Island to Texas to take part in the KSTAR program, hoping to gain more confidence as a surgeon and become more marketable.

Setting standards and removing obstacles

Reliable numbers of how many doctors suspend their practices aren’t available, but the American Medical Association estimated in 2011 that 10,000 doctors could reenter practice each year.

The Federation of State Medical Boards wants states to create a standard process for physicians to show they have the skills to return to medicine. It is asking licensing agencies to track whether doctors are still practicing and whether they are doing so in their area of training.

The American Academy of Pediatrics and the AMA also are trying to remove obstacles for doctors who want to return to work after taking time off. And Rep. John Sarbanes (D-Md.) has proposed legislation to help expand reentry programs for primary care doctors and help cover physicians’ costs if they agree to practice in high-need areas.

After hitting a wall with her former employer and others, Dr. Gibson enrolled in an online retraining program in San Diego, which cost her $7,000. She spent 4 months completing the courses last year and a week shadowing a family physician. Then she took a written exam and was evaluated during mock visits with “patients” played by actors.

In the end, she received two certificates – one from the program and one from the University of California, San Diego, for 180 hours of continuing medical education.

“I definitely felt more confident,” Dr. Gibson said. But she still wanted more hands-on clinical training. So she recently started a paid family medicine fellowship at the University of Southern California, seeing patients under the oversight of other doctors.

Former medical school professor Dr. Leonard Glass created the San Diego program, called the Physician Retraining and Reentry Program, in 2013. Besides retraining primary care doctors, the online program has attracted specialists who wanted to switch to primary care, as well as some restless retirees.

“Some are simply tired of being retired,” he said. “It’s sort of an itch to go back to taking care of people.”

‘Expensive and time consuming’

Several retraining programs are run by hospitals, including Cedars-Sinai Medical Center in Los Angeles. There, participants spend between 6 weeks and 3 months seeing patients under the supervision of other physicians, then discuss their cases in an exit interview to demonstrate what they learned. They leave with a letter that can be submitted to employers or hospitals.

The Cedars-Sinai program costs $5,000 a month. Dr. Leo A. Gordon, who runs it, said some doctors who call to inquire are angry about having to spend the time and money when they already have so much education and experience. But he said others are simply appreciative that “there is a way to get back in the game.”

One Cedars-Sinai graduate, Dr. Maria DiMeglio decided she wanted to return to practice as an ob.gyn. after taking off almost 6 years to care for her children and her ill mother.

“I thought I was retiring, Dr. DiMeglio said, “but I kept my options open.” She had retained her medical license and kept up with continuing education courses. But she needed to persuade her old hospital, Cedars-Sinai, to give her privileges so she could perform surgeries. The Cedars-Sinai retraining program, she said, “wasn’t difficult, but it was expensive and time consuming. Not everyone can do that.”

Hospitals set their own requirements for doctors to get credentials and privileges, but doctors who have been out of practice for more than 2 years generally must show that they are competent to see patients. Having a certificate from a reentry program helps, said Dr. David Perrott, senior vice president and chief medical officer of the California Hospital Association.

Dr. Jeff Petrozzino, a 50-year old doctor who trained in pediatrics and neonatology, knows all about that. He ran into difficulty returning to clinical practice after spending several years doing health economics research.

“I was a double board–certified physician licensed in several states,” he said. “You would think I would be able to get a job.”

When he finally did get an offer at a medical center in New Jersey, he said both the position and the state medical license were contingent on him getting retrained. He completed a 2-month program at Drexel University in 2013, where he was surprised to discover many other doctors in a similar situation.

Dr. Petrozzino said he was grateful for the program – but given the hassles of reentry, he would advise doctors to plan carefully before taking a break from practice.

“Careers are interrupted or derailed for various reasons,” he said. “The system does not readily allow for reentry.”

Kaiser Health News (KHN) is a nonprofit national health policy news service. Blue Shield of California Foundation helps fund KHN coverage in California.

After taking a 10-year break from practicing medicine to raise four sons, Dr. Kate Gibson was ready to go back to work.

The family physician had been reading about a shortage of primary care doctors and knew she could help. But when Dr. Gibson, 51, applied to work at her former hospital near Los Angeles, she was turned away. She’d been out of clinical practice too long.

“I really thought it was not going to be that hard,” she said.

Like many professionals, physicians take time off to raise children, care for sick family members, or recover from their own illnesses. Some want to return from retirement or switch from nonclinical jobs back to seeing patients. But picking up where they left off is more difficult in medicine than in most careers.

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In medicine, change occurs quickly. Drugs, devices, and surgical techniques that were standard a decade ago may now be obsolete. Or a returning doctor’s skills may simply be rusty.

“My hands feel like those of an intern,” said Dr. Molly Carey, 36, an Ivy League–educated doctor who recently enrolled in a Texas retraining program after 4 years away from patients.

After extended leaves, doctors must convince medical boards to reissue their licenses, hospitals to grant admitting privileges, and malpractice insurers to provide coverage. Only a handful of programs around the country are set up to help physicians brush up on their skills, and they can cost doctors thousands of dollars.

“Medical schools do a fantastic job graduating brand new medical students,” said Dr. Humayun J. Chaudhry, president of the Federation of State Medical Boards. “But what about people who have already graduated and need to get some retraining? There is clearly a dearth of those kind of training programs.”

Policy makers and professional organizations are pushing to make the process less burdensome and costly – in part because it may help ease shortages of primary care doctors.

Getting experienced doctors to dust off their white coats is cheaper than starting from scratch, said Dr. Robert Steele, director of KSTAR physician programs at Texas A&M Health Science Center, College Station. He oversees a miniresidency program at the University of Texas Medical Branch, Galveston, in which returning doctors divide their time between seeing patients and attending classes. The 3-month training includes the latest on medications, procedures, disease management, and treatment.

“[Returning doctors] just need polishing up to practice safely and competently,” Dr. Steele said.

Patient safety advocates argue that minimum standards should be set to ensure that doctors coming back after a hiatus are providing the best care possible. As it stands, no nationwide standards or requirements exist, and states have different requirements.

“Patients would like to think that any doctor who is seeing them or doing procedures on them is at the height of their career,” said Joe Kiani, founder of the Patient Safety Movement Foundation. “If a doctor has been out for a while, they are not.”

Dr. Carey had a great education, graduating from medical school at the University of Pennsylvania and completing a residency in 2011 in obstetrics and gynecology at Brown University and a Providence hospital. But after taking just 4 years off to care for a sick grandmother and another relative, she felt she needed to freshen her clinical skills. So she moved from Rhode Island to Texas to take part in the KSTAR program, hoping to gain more confidence as a surgeon and become more marketable.

Setting standards and removing obstacles

Reliable numbers of how many doctors suspend their practices aren’t available, but the American Medical Association estimated in 2011 that 10,000 doctors could reenter practice each year.

The Federation of State Medical Boards wants states to create a standard process for physicians to show they have the skills to return to medicine. It is asking licensing agencies to track whether doctors are still practicing and whether they are doing so in their area of training.

The American Academy of Pediatrics and the AMA also are trying to remove obstacles for doctors who want to return to work after taking time off. And Rep. John Sarbanes (D-Md.) has proposed legislation to help expand reentry programs for primary care doctors and help cover physicians’ costs if they agree to practice in high-need areas.

After hitting a wall with her former employer and others, Dr. Gibson enrolled in an online retraining program in San Diego, which cost her $7,000. She spent 4 months completing the courses last year and a week shadowing a family physician. Then she took a written exam and was evaluated during mock visits with “patients” played by actors.

In the end, she received two certificates – one from the program and one from the University of California, San Diego, for 180 hours of continuing medical education.

“I definitely felt more confident,” Dr. Gibson said. But she still wanted more hands-on clinical training. So she recently started a paid family medicine fellowship at the University of Southern California, seeing patients under the oversight of other doctors.

Former medical school professor Dr. Leonard Glass created the San Diego program, called the Physician Retraining and Reentry Program, in 2013. Besides retraining primary care doctors, the online program has attracted specialists who wanted to switch to primary care, as well as some restless retirees.

“Some are simply tired of being retired,” he said. “It’s sort of an itch to go back to taking care of people.”

‘Expensive and time consuming’

Several retraining programs are run by hospitals, including Cedars-Sinai Medical Center in Los Angeles. There, participants spend between 6 weeks and 3 months seeing patients under the supervision of other physicians, then discuss their cases in an exit interview to demonstrate what they learned. They leave with a letter that can be submitted to employers or hospitals.

The Cedars-Sinai program costs $5,000 a month. Dr. Leo A. Gordon, who runs it, said some doctors who call to inquire are angry about having to spend the time and money when they already have so much education and experience. But he said others are simply appreciative that “there is a way to get back in the game.”

One Cedars-Sinai graduate, Dr. Maria DiMeglio decided she wanted to return to practice as an ob.gyn. after taking off almost 6 years to care for her children and her ill mother.

“I thought I was retiring, Dr. DiMeglio said, “but I kept my options open.” She had retained her medical license and kept up with continuing education courses. But she needed to persuade her old hospital, Cedars-Sinai, to give her privileges so she could perform surgeries. The Cedars-Sinai retraining program, she said, “wasn’t difficult, but it was expensive and time consuming. Not everyone can do that.”

Hospitals set their own requirements for doctors to get credentials and privileges, but doctors who have been out of practice for more than 2 years generally must show that they are competent to see patients. Having a certificate from a reentry program helps, said Dr. David Perrott, senior vice president and chief medical officer of the California Hospital Association.

Dr. Jeff Petrozzino, a 50-year old doctor who trained in pediatrics and neonatology, knows all about that. He ran into difficulty returning to clinical practice after spending several years doing health economics research.

“I was a double board–certified physician licensed in several states,” he said. “You would think I would be able to get a job.”

When he finally did get an offer at a medical center in New Jersey, he said both the position and the state medical license were contingent on him getting retrained. He completed a 2-month program at Drexel University in 2013, where he was surprised to discover many other doctors in a similar situation.

Dr. Petrozzino said he was grateful for the program – but given the hassles of reentry, he would advise doctors to plan carefully before taking a break from practice.

“Careers are interrupted or derailed for various reasons,” he said. “The system does not readily allow for reentry.”

Kaiser Health News (KHN) is a nonprofit national health policy news service. Blue Shield of California Foundation helps fund KHN coverage in California.